N.Y. Comp. Codes R. & Regs. tit. 18 § 414.11

Current through Vol. 43, No. 18, May 5, 2021
Section 414.11 - Health and infection control
(a)Child enrollment requirements.
(1) The program must obtain an individual health plan for any child identified as a child with special health care needs, prior to the child being in attendance at the program.
(i) A child's individual health care plan must provide all information needed to safely care for the child.
(ii) A child's individual health care plan must be developed with the child's parent and health care provider.
(b)Staff and volunteers health requirements.
(1) Staff and volunteers must each submit a medical statement on forms furnished by the office or an approved equivalent from a health care provider:
(i) at the time of initial school age child care program application;
(ii) before such person has any involvement in child care work.
(2) Thereafter a medical statement will be required when an event or condition reasonably calls into question a staff person's ability to provide safe and suitable child care.
(3) Initial medical statements sent in with the application or as a result of a new hire must be dated within 12 months preceding the date of application or hiring date.
(4) The medical statement must give satisfactory evidence that the individual is physically fit to provide child day care and has no diagnosed psychiatric or emotional disorder which would preclude such individual from providing child day care.
(5) All staff and volunteers must be free from communicable disease unless his/her health care provider has indicated that the presence of the communicable disease does not pose a risk to the health and safety of the children in care.
(6) The initial medical statement for staff and volunteers must include the results of a Mantoux tuberculin test or other federally approved tuberculin test performed within the 12 months preceding the date of the application.
(7) After the initial medical statement, tuberculin tests are only required at the discretion of the staff person's or volunteer's health care provider or at the start of new employment.
(8) Consumption of, or being under the influence of alcohol by any staff person or volunteer is prohibited during child day care hours.
(9) Consumption of or being under the influence of an illegal drug by any staff person or volunteer is prohibited during child day care hours.
(10) Consumption of or being under the influences of a controlled substance by any staff person or volunteer is prohibited during day care hours, unless the controlled substance is prescribed by a health care provider is being taken as directed, and does not interfere with the person's ability to perform his or her child day care functions.
(11) Smoking in indoor or outdoor areas in use by children and in vehicles when children are occupying the vehicles is prohibited.
(12) The director and all teachers must have knowledge of and access to children's individual health records and all emergency information.
(13) Staff must be aware of each child's special health care needs identified in the child's individual health care plan. This includes, but is not limited to, allergies, disabilities and medical conditions.
(14) Staff must obtain assistance as identified in the child's individual health care plan if the child has a medical emergency.
(c)The health care plan.
(1) The registrant must prepare a health care plan on forms furnished by the office. Such plan must protect and promote the health of children. The health care plan must be on site, followed by all staff and available upon demand by a parent or the office. In those instances in which the program will administer medications, the health care plan must also be approved by the program's health care consultant unless the only medications to be administered are:
(i) over-the-counter topical ointments, lotions and creams, sprays, including sunscreen products and topically applied insect repellant; and/or
(ii) epinephrine auto injectors, diphenhydramine in combination with the auto injector, asthma inhalers and nebulizers.
(2) The health care plan must describe the following:
(i) how a daily health check of each child for any indication of illness, injury, abuse or maltreatment will be conducted and documented;
(ii) how a record of each child's illnesses, injuries and signs of suspected abuse or maltreatment will be maintained;
(iii) how professional assistance will be obtained in emergencies;
(iv) the advance arrangements for the care of any child who has or develops symptoms of illness or is injured, including notifying the child's parent;
(v) which designated staff will be administering medication. The plan must state that only a trained, designated staff may administer medications to children, except in those programs in which the only administration of medications offered will be the administration of over-the-counter topical ointments, lotions, creams, and sprays including sunscreen products and topically applied insect repellant;
(vi) the contents of the first aid kit;
(vii) that the trained designated staff person may only administer medications to children if the designated staff person is:
(a) at least 18 years of age;
(b) possesses a current certification in first aid and cardio-pulmonary resuscitation (CPR) appropriate to the ages of the children in care;
(c) and has completed the medication administration training (MAT) pursuant to subdivision (e) of this section or in the case of administering epinephrine auto injectors, diphenhydramine in combination with the auto injector, asthma inhalers and nebulizers has received training on its use from the parent, health care provider or a health care consultant;
(viii) the designation of the health care consultant of record for programs, as indicated in paragraph (1) of this subdivision; and
(ix) when a health care consultant is required to approve a health care plan the schedule of visits by a health care consultant to programs administering medications, must occur at least once every two years and must include a review of the health care policies and procedures and a review of the documentation.
(d)Health care consultant.
(1) Programs must demonstrate to the health care consultant how medications are administered in the program. A program is not required to schedule a visit with a health care consultant or include a schedule of visits by a health care consultant in their health care plan when:
(i) only over-the-counter topical ointments, lotions, creams and sprays, including sunscreen products and topically applied insect repellant are administered; and/or
(ii) epinephrine auto injectors, diphenhydramine in combination with the auto injector, and asthma inhalers and nebulizers are the only medications administered in the program.
(2) Should the health care consultant determine, after a visit to the day care program, that the approved health care plan is not being reasonably followed by the program, the health care consultant may revoke his or her approval of the plan. If the health care consultant revokes his or her approval of the health care plan, the health care consultant must immediately notify the registrant and the registrant must immediately notify the office, no longer than 24 hours later. In that instance, the health care consultant may also notify the office directly if he or she so desires.
(3) A program authorized to administer medications, which has had the authorization to administer medications revoked, or otherwise loses the ability to administer medications, must advise the parent of every child in care before the next day the program operates that the program no longer has the ability to administer medications.
(4) A program, whose health care consultant terminates his or her relationship with the program, will be granted a 60-day grace period to hire another health care consultant, obtain approval of a health care plan from the new health care consultant and submit the plan to the office without the child care program losing the ability to administer medications as long as:
(i) the former health care consultant did not revoke his or her approval prior to terminating the relationship with the child care program;
(ii) staff who have been trained in medication administration are available to continue administration of medications as per the health care plan;
(iii) the child care program follows the approved health care plan, as currently written, for the 60-day period;
(iv) the child care program notifies the office, within 24 hours, of the termination of the relationship with the health care consultant; and
(v) the child care program has the newly hired health care consultant review and approve the health care plan and sends the signed approved health care plan to the office before the 60-day window expires.
(5) Once the 60-day period has expired if no health care plan approval is issued, the child care program will be issued a new registration, which will state that it is no longer able to administer medications other than over-the-counter topical medications and emergency medications.
(e)Training for the administration of medications.
(1) All staff, except those excluded pursuant to paragraph (5) of this subdivision, subdivision (f) and paragraph (h)(5) of this section who have agreed to administer medication must complete the office-approved medication administration training or an office-approved equivalent before administering medications to children in day care. The certification of training in the administration of medications to children in day care shall be effective for a period of three-years from the date of issuance. The staff person must complete a recertification training approved by the office in order to extend the certification for each additional three year period. Where a certification lapses, the staff person may not be recertified unless the staff person completes the initial medication administration training or the recertification training, as required by the office. Where enforcement action has been taken against the registrant based on a failure by the program to comply with requirements for the administration of medications set forth in this section, the office may require retraining or may prohibit a staff person from being involved in the administration of medications.
(2) Staff who will be responsible for administering medications must receive training in the methods of administering medications prior to administering any medications in a child day care setting. Upon completion of the training, the staff person must receive a written certificate from the trainer that indicates that the trainee has successfully completed this training program, as required, and demonstrated competency in the administration of medications in a day care setting.
(i) In order to be trained in the administration of medications in a day care setting, a staff person must be literate in the language or languages in which health care instructions from parents and health care providers will be received.
(ii) Persons who receive training in the administration of medications in day care settings pursuant to this section may not otherwise administer medications or represent themselves as being able to administer medications except to the extent such persons may be able to do so in accordance with the relevant provisions of the Education Law.
(3) The training in the administration of medications must be provided by a health care provider or registered nurse who has been certified by the office to administer the office approved curriculum.
(4) The training must be documented and must include, but need not be limited to the following:
(i) training objectives;
(ii) a description of the methods of administration including principles and techniques of application and dispensation of oral, topical, medication patches and inhalant medication, including the use of nebulizers, and the use of epinephrine auto-injector devices when necessary to prevent anaphylaxis in emergency situations with respect to the various age groups of children;
(iii) administering medication to an uncooperative child;
(iv) an evaluation of whether the trainee demonstrates competency in:
(a) understanding orders from the health care professional or licensed authorized prescriber;
(b) the ability to correctly carry out the orders given by the health care provider or licensed authorized prescriber;
(c) recognition of common side effects of medications and ability to follow written directions regarding appropriate follow-up action;
(d) avoidance of medication errors and what action to take if an error occurs;
(e) understanding relevant commonly used abbreviations;
(f) maintaining required documentation including the parent's permission, written orders from health care professionals and licensed authorized prescribers, and the record of administration of medications;
(g) safe handling of medications, including receiving medications from a parent;
(h) proper storage of medications, including controlled substances; and
(i) safe disposal of medications.
(5) A person who can produce a valid New York State license as a physician, physician's assistant, registered nurse, nurse practitioner, licensed practical nurse or advanced emergency medical technician will not be required to attend the training required by subdivision (e) of this section in order to administer medications in a day care program. Documentation establishing the person's credentials in one of the above fields will be required and a copy of the documentation must be provided to the office.
(f) Administration of medication.
(1) Staff may administer medication only in accordance with the following:
(i) All programs that choose to administer medications other than epinephrine auto injectors, diphenhydramine in combination with the auto injector, asthma inhalers and nebulizers, topical ointments, lotions, creams and sprays to children must have a health care consultant of record and must address the administration of medications in the health care plan in accordance with the requirements of this section.
(ii) The program must confer with a health care consultant regarding the program's policies and procedures related to the administration of medications. This consultation must include a review of the documentation that all staff authorized to administer medications have the necessary professional license or have completed the necessary training.
(iii) Policies regarding the administration of medications must be explained to the parent at the time of enrollment of the child in care and when substantive changes are made thereafter. Parents must be made familiar with the policies of the day care program relevant to the administration of medications.
(iv) Nothing in this section shall be deemed to require any program to administer any medication, treatment, or other remedy except to the extent that such medication, treatment or remedy is required under the provisions of the Americans with Disabilities Act.
(v) Nothing in this Part shall be deemed to prevent a parent, or relative within the third degree of consanguinity of the parents or step-parents of a child, even if such a person is a staff person or volunteer of the program, from administering medications to a child while the child is attending the program even if the registrant has chosen not to administer medications or if the staff designated to administer medications is not present when the child receives the medication.
(2) If the registrant elects not to administer medications, the program must still document the dosages and time as per paragraph (9) of this of this subdivision that the medications were given to the child by the child's parent, or relative within the third degree of consanguinity of the parents or step-parents of the child.
(i) Relatives within the third degree of consanguinity administering medications to the child in day care must be at least 18 years of age, unless that relative is the parent of the child.
(ii) If the only administration of medication in a day care program is done by a parent, or relative within the third degree of consanguinity of the parents or step-parents of a child, the staff of the program do not have to complete the administration of medication training requirements pursuant to subdivision (e) of this section.
(3) No child in care will be allowed to independently administer medications, except for those medications administered pursuant to paragraph (h)(6) of this section, without the assistance and direct supervision of staff who are authorized to administer medications pursuant to this section. Any program that elects to offer the administration of medication to children when children who attend the program independently administer medications or when children assist in the administration of their own medications must comply with all the provisions of this section.
(4) Staff may administer prescription and non-prescription (over-the-counter) medications for eyes or ears, oral medications, topical ointments, creams, lotions, sprays and medication patches and inhaled medications in accordance with this section.
(5) Staff may not administer medications by injection, vaginally or rectally except as follows:
(i) where the staff person has been certified to administer medications in a day care setting and the parent and the child's health care provider have indicated such treatment is appropriate and received instruction on the administration of the medication; or
(ii) for a child with special health care needs, where the parent, day care program and the child's health care provider have agreed on a plan pursuant to which the staff may administer medications by injection, vaginally or rectally; or
(iii) where the staff person has a valid license as a physician, physician's assistant, registered nurse, nurse practitioner, licensed practical nurse or advanced emergency medical technician.
(6) Staff authorized to administer medication who agree to administer medications to a child must do so, unless they observe the circumstances, if any, specified by the health care provider or the medication label, under which the medication must not be administered. In such instances, the program must contact the parent immediately.
(7) Permissions needed from parent and/or health care provider in order to administer medications.
(i) Over-the-counter products, including but not limited to over-the-counter topical ointments, lotions, creams, sprays, including sunscreen products and topically applied insect repellant can be administered by the program for one day only, with verbal permission of the parent. If an over-the-counter product is to be administered on a subsequent day or an ongoing basis, written permission from the parent must have been provided to the program.
(ii) Prescription medications, oral over-the-counter medications, medicated patches, and eye, ear, or nasal drops or sprays, can be administered by the program for one day only, with the verbal permission of the parent. If prescription medications, oral over-the-counter medications, medicated patches, and eye, ear, or nasal drops or sprays are to be administered on a subsequent day or an ongoing basis, written permission from the parent and written instructions from the health care provider must have been provided to the program prior to such administration.
(iii) A staff person cannot administer medication to any child in care, if the parent's instructions differ from the instructions on the medication's packaging, until the program receives permission from a health care provider or licensed authorized prescriber on how to administer the medication.
(iv) The program must immediately notify the parent if the program will not administer medication due to differing instructions related to the administration of medication.
(8) Staff who are authorized to administer medications must administer medication as follows:
(i) to the right child;
(ii) at the right dose;
(iii) at the right time;
(iv) with the right medication; and
(v) through the right route.
(9) Documentation of medication administration.
(i) At the time of administration, the staff person must document the dosages and time that the medications are given to the child.
(ii) All observable side effects must be documented and communicated to the parent, and when appropriate, the child's health care provider.
(iii) Documentation must be made if the medication was not given and the reason for such a decision.
(10) The parent must be notified immediately and the office must be notified within 24 hours of any medication administration errors. Notification to the office must be reported on a form provided by the office or on an approved equivalent.
(11) All verbal permissions received pursuant to this subdivision must be documented.
(12) Staff who are authorized to administer medications must be literate in the language for which the permissions and instructions for use are written.
(13) Medication must be returned to the parent or guardian when it is no longer required by the child or, with the permission of the parent or guardian, be properly disposed of by the program.
(14) Where the program has received written permission of the parent and written instructions from the health care provider authorizing administration of a specified medication if the staff person observes some specified condition or change of condition in the child while the child is in care, the staff person may administer the specified medication, without obtaining additional authorization from the parent or health care provider.
(15) Prescription and over-the-counter medications must be kept in their original bottles or containers.
(16) Prescription medication labels must include the following information or be available through the licensed authorized prescriber on the form provided by the office or equivalent form:
(i) child's first and last name;
(ii) licensed authorized prescriber's name, telephone number, and signature;
(iii) date authorized;
(iv) name of medication and dosage;
(v) frequency the medication is to be administered;
(vi) method of administration;
(vii) reason for medication (unless this information must remain confidential pursuant to law);
(viii) most common side effects or reactions; and
(ix) special instructions or considerations, including but not limited to possible interactions with other medications the child is receiving, or concerns regarding the use of the medication as it relates to a child's age, allergies, or any pre-existing conditions.
(17) Medications must be kept in a clean area that is inaccessible to children.
(18) If refrigeration is required, the medication must be stored in either a separate refrigerator or a leak-proof container in a designated area of a food storage refrigerator, separated from food and inaccessible to children.
(19) Day care programs must comply with all Federal and State requirements for the storage and disposal of all types of medications, including controlled substances.
(20) In the case of medication that needs to be given on an ongoing, long-term basis, the authorization and consent forms for children must be reauthorized at least once every 12 months. Any changes in the medication authorization related to dosage, time or frequency of administration shall require a program to obtain new instructions written by the licensed authorized prescriber. All other changes to the original medication authorization require a change in the prescription.
(g)Stocking medications.
(1) A child care program may keep a supply of over-the-counter medications at a program site to be used in the event that a child in the program develops symptoms while in care that indicate the need for over-the-counter medication.
(2) Child care programs that store and administer medication that is not labeled for a specific child must have an over-the-counter stock medication policy in place before beginning to store any over-the-counter medications. The over-the-counter stock medication's policy must address the safe storage and proper administration of the stored over-the-counter medication and must address the need for strict infection control practices as they pertain to stock medication.
(3) Stock medication must be kept in a clean area that is inaccessible to children and any stock medication must be stored separate from child specific medication.
(4) Stock medications must be kept in the original container and have the following information on the label or in the package insert:
(i) name of the medication;
(ii) reasons for use;
(iii) directions for use, including route of administration;
(iv) dosage instruction;
(v) possible side effects and/or adverse reactions;
(vi) warnings or conditions under which it is inadvisable to administer the medication; and
(vii) expiration date.
(5) Child care programs that stock supplies of over-the-counter medication, which are not in single dose packaging, must provide a separate mechanism to administer the medication for each child that may need the medication. Once a device has been used for a specific child in care, that specific device must be disposed of or reused only for that specific child and must be labeled with the child's first and last name. The program must include the procedure in the over-the-counter stock medication policy for dispensing the stock medication from the container to the device, or directly administering to the child, without contaminating the stock medication.
(6) All stock medication must be administered using best practice techniques in accordance with the directions for use on the medication package.
(7) School age child care programs may not stock prescription medication.
(h)Emergency care and the administration of epinephrine, diphenhydramine in combination with the auto injector, asthma inhalers and nebulizers.
(1) The program must immediately call 911 for children who require emergency medical care and also must:
(i) obtain written consent at the time of admission from the parent which authorizes the program to obtain emergency health care for the child;
(ii) arrange for the transportation of any child in need of emergency health care, and for the supervision of the children remaining in the program;
(iii) in the event of an accident or illness requiring immediate health care, secure such care and notify the parent; and
(iv) advise a parent or the person authorized to pick up the child that day, of any developing symptoms of illness or minor injury sustained while child is in care.
(2) The school age child care program must be equipped with a portable first aid kit which is accessible for emergency treatment. The first aid kit must be stocked to treat a broad range of injuries and situations and must be restocked as necessary. The first aid kit and any other first aid supplies must be kept in a clean, covered container or cabinet inaccessible to children.
(3) Rectal thermometers may not be used.
(4) The program must provide a child who has or develops symptoms of illness a place to rest quietly that is in the view of, and under the supervision of a staff person until the child receives medical care or the parent or approved parental designee arrives. In the event that a child has or develops symptoms of illness, the program is responsible for immediately notifying the parent.
(5) When a program has not been authorized to administer medications in a day care setting in accordance with the requirements of subdivision (f) of this section a designated staff may administer emergency care through the use of epinephrine auto-injector devices, diphenhydramine, when prescribed in combination with the auto injector, asthma inhaler and asthma nebulizer when necessary to prevent anaphylaxis or breathing difficulty for an individual child but only when the parent and the child's health care provider have indicated such treatment is appropriate. In addition:
(i) a written individual health care plan must be developed for the child;
(ii) the child's health care provider must issue a standing order and prescription for the medication;
(iii) the parent must approve, in writing, the administration of the medication as prescribed by the health care provider and keep medications current;
(iv) all staff administering an emergency medication pursuant to paragraph (h)(5) of this section, must be instructed on its use; and, the instruction must be provided by the parent, the child's health care provider or a health care consultant;
(v) staff who have been instructed on the use of the auto injector, diphenhydramine, inhaler or nebulizer must be present during all hours the child with the potential emergency condition is in care;
(vi) the staff person administering the auto-injector, diphenhydramine, asthma medication or nebulizer must be at least 18 years old;
(vii) the program must immediately contact 911 after administration of epinephrine;
(viii) if an inhaler or nebulizer for asthma is administered, the program must call 911 if the child's breathing does not return to its normal functioning after its use; and
(ix) storage, documentation of the administration of medication and labeling of the auto-injector, asthma inhaler and asthma nebulizer must be in compliance with this section.
(6) When a program is approved to administer an inhaler to a child with asthma or other diagnosed respiratory condition, or an epinephrine auto injector for anaphylaxis, a school-aged child may carry and use these devices during day care hours if the program secures written permission of such use of a duly authorized health care provider, parental consent and completes a special health care plan for the child.
(7) The special health care plan, parental consent and health care provider consent documenting permission for a school-age child to carry an inhaler or auto injector must be maintained on file by the program.
(i)Infection control.
(1) Staff and volunteers must thoroughly wash their hands with soap and running water at the beginning of each day, before and after the administration of medications, when they are dirty, after toileting, before and after food handling or eating, after handling pets or other animals, after contact with any bodily secretion or fluid, and after coming in from outdoors.
(2) Staff and volunteers must ensure that children thoroughly wash their hands or assist children with thoroughly washing their hands with soap and running water when they are dirty, after toileting, before and after food handling or eating, after handling pets or other animals, after contact with any bodily secretion or fluid, and after coming in from outdoors.
(3) Staff must assist children in keeping clean and comfortable, and in learning appropriate personal hygiene practices.
(4) When soap and running water is not available, hand sanitizer may be used by children, staff and volunteers on visibly clean hands. Package directions must be followed including supervision of children so that ingestion does not occur.
(i) When soap and running water is not available and hands are visibly soiled, individual wipes may be used in combination with hand sanitizer.
(5) Safety precautions relating to blood must be observed by all staff and volunteers as follows:
(i) Disposable gloves must be immediately available and worn whenever there is a possibility for contact with blood, including but not limited to:
(a) touching blood or blood-contaminated body fluids;
(b) treating cuts that bleed; and
(c) wiping surfaces stained with blood.
(ii) In an emergency, a child's well-being must take priority. A bleeding child must not be denied care because gloves are not immediately available.
(iii) Disposable gloves must be discarded after each use.
(iv) If blood is touched accidentally, the exposed skin must be thoroughly washed with soap and running water.
(v) Clothes contaminated with blood must be placed in a securely tied plastic bag and returned to the parent at the end of the day.
(vi) Surfaces that have been blood stained must be cleaned and then disinfected with an Environmental Protection Agency (EPA) registered product that has an EPA registration number on the label.
(6) All rooms, equipment, surfaces, supplies and furnishings accessible to children must be cleaned and then sanitized or disinfected, using an EPA registered product, as needed to protect the health of children, and in a manner consistent with the program's health care plan approved by the office.
(7) Equipment that is frequently used or touched by children on a daily basis must be cleaned and then sanitized or disinfected, using an EPA registered product, when soiled and at least once weekly.
(8) The premises must be kept clean and free from dampness, odors and the accumulation of trash.
(9) The premises must be kept free of vermin.
(10) Carpets contaminated with body fluids must be spot cleaned.
(11) Extensive cleaning, such as shampooing carpets or washing windows and walls, must occur when children are not present.
(12) Garbage receptacles must be cleaned as needed after emptying.
(13) Thermometers must be washed and disinfected before use by another child.
(14) Individual drinking cups or disposable cups must be provided daily. Once a drinking cup or eating utensils have been used by a child they may not be used by another child unless they are washed first.
(15) Between uses, dishes and utensils must be washed with soap and hot water and rinsed in hot running water.
(16) Linens, blankets and bedding must be cleaned at least weekly and before use by another child. Cots, beds, mats and mattresses must be cleaned thoroughly between uses by different children and at least monthly.
(17) Sanitizers and disinfectants must be used as directed on the product label.
(18) Hygiene and bathroom facilities.
(i) Toilet facilities must be kept clean at all times, and must be supplied with toilet paper, soap and towels accessible to the children.
(ii) Air blowers/dryers may be used in place of hand towels where available.
(j)Pesticide use.
(1) Any application of pesticides (as the term pesticide is defined in section 33-0101 of the Environmental Conservation Law) shall be completed in accordance with the requirements of section 390-c of the Social Services Law and sections 33-1004 and 33-1005 of the Environmental Conservation Law.
(2) In addition to the requirements of section 390-c of the Social Services Law, each day care facility must send a notice home with each child or otherwise provide notification to the parent of each child not less than 48 hours prior to the application of pesticides. Such notice must include:
(i) the location and specific date of the application of pesticides and may include two alternate dates in the event that an outdoor application cannot be made due to weather conditions;
(ii) the pesticide product name and pesticide registration number assigned by the United States Environmental Protection Agency;
(iii) the following statement: "This notice is to inform you of a pending pesticide application at this facility. You may wish to discuss with a representative of the day care facility what precautions are being taken to protect your child from exposure to these pesticides. Further information about the product or products being applied, including any warnings that appear on the label of the pesticide or pesticides that are pertinent to the protection of humans, animals or the environment, can be obtained by calling the National Pesticide Information Center at 1-800-858-7378 or the New York State Department of Health Center for Environmental Health Info Line at 1-800-458-1158"; and
(iv) the name of a representative of the day care facility and contact number for additional information.
(3) Any day care program that fails to send the appropriate notice of pesticide application as set forth in paragraph (2) of this subdivision, for a first such violation, shall be issued a written warning in lieu of penalty. For a second violation, such program shall be subject to a penalty not to exceed $100. For any subsequent violation, such program shall be subject to a penalty not to exceed $250 for each violation. No penalty may be assessed by the commissioner without affording the registrant with notice and an opportunity for a hearing pursuant to section 413.5 of this Title.
(4) Any finding by the Department of Environmental Conservation of a violation by the program of the requirements set forth in section 33-1004 or 33-1005 of the Environmental Conservation Law shall be deemed a safety hazard to children in care and a violation of this subdivision.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 414.11

Amended New York State Register June 3, 2020/Volume XLII, Issue 22, eff. 6/3/2020